Sickness Absence Research Articles

Sickness absence after work injuries and post-traumatic stress among white-collar workers

Abstract Background There is very little knowledge about sickness absence (SA) and disability pension (DP) after work injuries and post-traumatic stress disorder (PTSD) among white collar workers. The aim was to examine diagnosis-specific SA and DP after healthcare due to a workplace injury and PTSD, respectively, among white-collar workers in the wholesale and retail industry in Sweden. Methods A prospective population-based cohort study of all 192,077 such white-collar workers (44% women) in Sweden in 2012, using linked microdata from three nationwide registers covering 2012-2016. We identified individuals who had specialised out- or inpatient healthcare due to a work injury (n = 1114) or to PTSD (n = 216) in the years 2012-2016. Their average number of net days of diagnosis-specific SA and DP was calculated for the 365 days before and 365 days after the healthcare visit. Results 64% of women and 45% of the men had at least one new SA spell during the 365 days after healthcare due to a work injury. On average, women had 14 SA/DP days the year before the injury and 31 days after; corresponding days for men were 9 and 21 days. SA days with fractures and with other injuries increased most, while SA days with mental diagnoses increased slightly. In the PTSD group, 80% of women and 65% of men had a new SA spell. Women's SA/DP days increased from 121 to 157 and men's from 112 to 174. SA with stress-related disorders and other mental diagnoses increased most, while DP with stress-related diagnoses and SA with musculoskeletal diagnoses increased slightly. Conclusions About half of those who had healthcare due to work injuries, and the majority of those who had PTSD, had new SA following the healthcare. SA due to diagnoses related to injury and mental diagnoses, respectively, increased most, however, SA/DP days due to other diagnoses also increased slightly. More knowledge is needed on factors associated with having or not having SA/DP with different diagnoses after work injuries and PTSD. Key messages • About half of those who had specialised healthcare due to work injuries, and the majority of those who had PTSD, had new SA in the following 365 days. • Individuals with healthcare for PTSD had more SA/DP days both before and after their healthcare visit than those with work injuries, but individuals with work injuries had a larger increase.

Sick at work and future sickness absence - a prospective study of two measures of sickness presence

Abstract Background Sickness presence (SP), or going to work despite being ill, is a common way of practicing sickness absence (SA). However, its consequences for long-term SA are poorly understood, and there is no consensus on how to measure SP. This study aims to examine the consequences of SP on long-term sickness absence (>14 days) using two different measures. Methods Data from a Danish public human service organization were analyzed, with approximately 2400 employees answering questionnaires in November 2019, yielding a response rate of 50%. Information on SA, work environment, self-reported health, SP episodes, and sociodemographic information were included in negative binomial regression models. The outcome variable was prospective episodes of SA (>14 days) taken from the SA register of the organization. Two different ways of measuring SP were used: a traditional measure of overall SP frequency and a measure of going to work with specific symptoms (fever, cold, headache, musculoskeletal pain). Results Participants who reported SP frequency of more than 10 times during the last 6 months had a two-fold risk of long-term SA (IRR: 2.19 (95%CI 1.09-4.58)) in the follow-up period. This risk remained significant even after adjusting for work environment factors, sociodemographic factors, self-rated health, and spells of sickness absence in the previous year. Going to work with fever (IR: 1.43) or cold (IR: 1.48) was also associated with long-term SA in the follow-up period. Conclusions SP may negatively impact employees’ health status and increase long-term sickness absence. Health professionals should be aware of the negative consequences of focusing solely on reducing short-term sickness absence especially if they inadvertently encourage employees to substitute sickness presence for sickness absence. Key messages • Going to work despite having ill health is common but may have adverse health consequences and lead to long-term sickness absence. • Focusing narrowly on reducing short-term sickness absence might be a bad idea for public health. Employees might feel encouraged to go ill to work which could increase future sick leave.

Provisions regarding organizational and social work environment and future sickness absence in Sweden

Abstract Background Sickness absence is high among healthcare employees in many European countries, including Sweden. In addition to physical workload, the importance of psychosocial work factors for this is emphasized. To promote a good psychosocial work environment, provisions on organisational and social work environment, mandatory to all work sectors, was launched in 2016 in Sweden. We compared sickness absence (SA) due to mental diagnoses two years before and two years after these provisions were introduced, among healthcare employees, employed by the municipality, the region, or private organisations. Methods Register microdata were used for analyses of all employees in the healthcare sector in Sweden in 2014 (N = 260,709) and in 2018 (N = 277,901). The odds ratios (OR) with 95% confidence intervals (CI) of new SA (in SA spells >14 days) and of long-term SA (>90 days) with a mental diagnosis in 2018 compared to 2014 were calculated, using logistic regression. Results The ORs of new SA and long-term SA with mental diagnoses among healthcare employees were somewhat higher in 2018 than in 2014 (OR = 1.14; 95% CI 1.11-1.17), (OR = 1.12; 1.07-1.17). The OR for the private sector for a new SA spell was 1.11; 1.02-1.19, and for the regional sector, OR 1.05; 1.01-1.08. The highest probability of long-term SA with mental diagnoses in 2018 compared to 2014 was found among employees in the municipal sector, OR 1.33, CI; 1.11-1.61, and in the private sector, OR 1.15, CI; 1.03-1.29. Discussion The mandatory provisions aim to promote good work environment and prevent risks of ill health due to organisational and social conditions at work. We observed a somewhat higher probability of SA with mental diagnoses two years after the provisions were introduced. SA due to mental diagnoses is influenced by many factors of which psychosocial work environment is only one part and maybe longer follow-ups are needed. Key messages • Sickness absence due to mental diagnoses among healthcare employees was somewhat higher two years after the introduction of an organisational and social work environment provision. • Many factors influence sickness absence with mental diagnoses; other factors and longer follow-ups are needed to gain knowledge on possible effects of the work environment provision.

Night shift work and sickness absence – many for the few or few for the many?

Abstract Background Night shift work is related to adverse health outcomes. Yet, some choose working permanent night and it is speculated that they tolerate night work better. However, research on permanent night work is sparse. The aim was to study the association between organisation of night work and sickness absence. Should we allow many night shifts for the few or should we enforce few night shifts for the many? Methods Information on working hours, age (19-70 years), gender (women, men) and sickness absence (annual number of days) was obtained from 94 815 nurses and nurse assistants (88% women) from the Danish Working Hour Database (DAD). DAD contains daily information on working hours based on payroll data for all employees in Danish public hospitals (2017-2020). For each year with >50% work participation, individual schedules were classified into “no night shifts”, “1-50 night shifts”, “51-100 night shifts”, “101-150 night shifts” and “more than 150 night shifts”. We applied linear regression (with individual as random intercept) for risk of sickness absence the following year adjusted for age, gender and calendar year. Results Preliminary results showed night shift workers with more than 150 night shifts per year had 5.0 more sick days (95% CI: 3.5-6.4, p = <0.001) than employees with no night shifts. No statistically significant differences were observed between the four night shift groups. Conclusions Employees had more sickness absence the year after working during the night compared to employees without night shift work. However, no differences were seen when yearly comparing employees with many night shifts to those with few night shifts. The study adds to scientific support to guidelines on scheduling of shift work in governmental policies with the aim of securing healthy and safe workplaces. Key messages • Night shift workers have higher number of sick days compared to daytime workers; however, number of night shifts during a year did not affect the results. • The study adds value for the use of the scientific recommendations for minimizing health risk for night shift workers in governmental policies with the aim of securing healthy and safe workplaces.

Joint associations of leisure time physical activity and sitting time with sickness absence

Abstract Background Physical inactivity and prolonged sitting are risk factors for non-communicable diseases and threaten public health. The aim of this study was to examine the joint associations of leisure time physical activity and sitting time with sickness absence among Finnish adult population. Methods Randomly selected adults (N = 10 300, response rate 70,5 %) were asked to fill in questionnaire of the FinHealth 2017 population survey. The survey data were linked to the Finnish Social Insurance Institution's register data on sickness benefit periods (over 10 working days), including diagnoses (follow-up 2,9 years). Self-reported leisure time physical activity was classified into three groups: inactive, moderately active, and active and screen sitting time into two groups: ≤3hrs hours or less and over three hours a day, yielding a six-category variable for the joint analyses. The analytical sample were restricted to working age (18-63 years), which included 5183 participants. Associations were examined by using logistic regression analysis adjusting for key covariates with SPSS 29. Results Those who were inactive and spend a lot of time sitting in front of a screen (< 3h) during leisure had a higher risk for sickness absence due to mental disorders (OR = 2,07 95% CI 1,03-4,18) than physically active low sedentary group. Also, the inactive and low sedentary group (OR = 1,69 95% CI 1,12-2,55) and the moderately active and high sedentary group (OR = 2.06, 95% CI 1.15-3.67) had a higher risk. No significant differences were found for associations due to all-cause and musculoskeletal disorders sickness absence. Conclusions Alongside increasing leisure-time physical activity, reducing sedentary behavior can have a positive impact on the risk of sickness absence for mental health reasons. A reduction in sedentary behavior and an increase physical activity should be encouraged. Key messages • Sedentary behavior in leisure was associated to a higher occurrence of mental health sickness absence. • Attention should be paid to reducing sitting time and increasing physical activity.

Psychosocial work factors and sickness absence among young Danish workers with a disease history

Abstract Background Young workers with a disease history may be more sensitive to adverse work environment, which could lead to increased rates of sickness absence (SA). This study investigates the association between psychosocial work factors and SA among young Danish workers with a history of somatic or mental disorders (N = 39,772). Methods We included young workers (aged 15-30) with a history of hospital-diagnosed somatic or mental disorders before labor market entry (between 2010 and 2018). SA spells of any length (≥1 day) were measured in registers and psychosocial work factors were estimated on the occupational level using job exposure matrices. We separately estimated adjusted rate ratios (RR) and 95% confidence intervals (95% CI) for women and men using Poisson regressions. Results Among women, employment in occupations with high quantitative demands, low decision authority, high job strain, high emotional demands, or high work-related physical violence was associated with higher rates of SA. Employment in occupations with high vs. low emotional demands showed the strongest association with a RR of 1.56 (95% CI: 1.48-1.65). Among men, employment in occupations with low decision authority showed the strongest association (1.40 [1.32-1.48]). In contrast, employment in occupations with high quantitative demands or high job strain was associated with lower rates of SA. Conclusions In a large nationwide sample of young workers with a history of somatic or mental disorders, we found several psychosocial work factors associated with SA at the job group level. Associations were overall similar to previously published results on all young workers. The results indicate that young workers with a history of somatic or mental disorders may not be more sensitive to adverse working conditions concerning the risk of SA and that preventive interventions, toward reducing SA, may have a similar impact regardless of disease history. Key messages • Several psychosocial working conditions were associated at the job group level with sickness absence in a nationwide sample of young workers with a disease history. • Associations were similar to previous results indicating that young workers with a disease history may not be more sensitive to adverse working conditions compared to the overall workforce.

Time from sickness absence due to cancer until return to work by locations and sex, Catalonia, Spain

Abstract Background Number of people diagnosed with cancer in the workplace are expected to increase steadily. Sickness absence is a tool of social protection system through which workers with a health problem can get absence from work, while receive economic and medical support until they are able to return to their workplace. Methods Cohort study of 426 affiliates to Social Security (57.5% women), residents in Catalonia who suffered an sickness absence due to a cancer between 2012-2015. Individuals were followed up from the beginning of the sickness absence episode until return to work. Kaplan Meier survival estimates were applied, stratified by sex, to compare time until return to work distinguishing between different cancer locations. Results Median age among workers who returned to work after an sickness absence was 49.3 years (sd 9.2). Among men, most frequent locations were male genital organs (28.7%), digestive (23.2%) and urinary organs (22.7%), and among women, breast and female genital organs (61.2%) and skin neoplasm (21.6%). Maximum time until return to work was 11.2 months. The median time until return to work was 1 month in both sexes. In men, we found the longest median time in male genital organs with 38 days and the lowest in skin cancer with 10 days. In women, we found the longest median time in digestive and the lowest in skin neoplasms with 14 days. Kaplan Meier curves showed bigger differences in time to return to work between locations among women than among men. Differences between both sexes were found statistically significant (p < 0.0001). Conclusions Most of the people who survive a cancer go back to employment. Time until return to work vary between cancer locations and sexes. Studying return to work of people who suffer a cancer allows us to determine how the disease affects survivors and society to better understand specific needs of survivors and detecting vulnerable groups. Key messages • Time from sickness absence due to cancer until return to work vary between cancer locations and sexes. • Research on sickness absence in important to better understand specific needs of survivors and detecting vulnerable groups.

Prior morbidity and sickness absence with Covid-19 among wholesale and retail blue-collar workers

Abstract Background Cancer, cardiovascular disease, hypertension, diabetes, chronic kidney disorders, chronic lung disorders, neurological disorders, obesity, immunocompromisation, and schizophrenia or bipolar disorders were found to be risk factors for severe Covid-19. The aim was to determine associations between having such diagnoses and future sickness absence (SA) due to Covid-19 or related diagnoses in 2020. Methods A prospective population-based cohort study of all 299,268 blue-collar workers (48% women) in Sweden in 2018, using linked microdata from four nationwide registers covering 2018-2020. People with any of the above diagnoses in 2018 or 2019 were identified using microdata from specialised in- and outpatient healthcare and prescribed drugs. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) of a new SA spell >14 days due to diagnosed Covid-19 or one of the diagnoses used by the Social Insurance Agency for suspected Covid-19 in 2020, separately for each diagnosis group and a global estimate for all risk factors together, adjusted for sociodemographic characteristics. Results In total, 38,422 individuals had at least one of the diagnoses that was a risk factor for severe Covid-19. Of them, 284 individuals had SA due to Covid-19 or related diagnoses (0.7%) in 2020, while 1210 of those with no such risk factor for Covid-19 had SA due to Covid-19 or related diagnoses (0.5%). The adjusted OR of SA due to Covid-19 or related diagnoses was 1.37 (95% CI 1.20-1.56) for those who had any risk factors for severe Covid-19. The group of diagnoses with the highest adjusted OR for SA in Covid-19-related diagnoses was lung disease (2.23; 95% CI 1.93-2.56). Conclusions While only a few of those with prior morbidity that was a risk factor for severe Covid-19 had SA due to Covid-19 or related diagnoses in 2020, they had a higher risk than those without such prior morbidity. Key messages • Having prior morbidity with a diagnosis identified as a risk factor for severe Covid-19 was associated with a higher risk of having SA due to Covid-19 or related diagnoses in 2020. • Prior lung disease was the diagnosis group with the highest risk of SA due to Covid-19 or related diagnoses.

Sickness absence and/or disability pension and future work income after age 65 and 70 in Sweden

Abstract Background As retirement ages are increasing in Europe, more knowledge is needed on factors that are associated with extended working life. Our aim was to explore if prior sickness absence (SA) and/or disability pension (DP) due to mental and/or somatic diagnoses were associated with income from work after age 65 and 70, respectively. Methods A 4-year prospective population-based cohort study using microdata from nationwide registers. We included all who in 2014 were aged 65-69 (cohort A; n = 201,263) and ≥70 (cohort B; n = 93,751), respectively, had income from work in 2014 (baseline), and lived in Sweden in 2010-2015. Cox proportional hazard regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI) for associations between prior SA (in spells >14 days) and/or DP due to mental and/or somatic diagnoses, overall and stratified by the number of net days (2010-2014), and future years with income from work (2015-2018), censored for death and emigration, adjusted for sociodemographic and work-related factors, and stratified by sex. Results The majority had no SA or DP during the exposure interval (cohort A 66.3% women, 75.8% men; cohort B 96.8% women, 97% men). Many had income from work at some point during follow-up (cohort A 77.8% women, 81.6% men, cohort B 81.9% women, 83.4% men). Prior somatic SA/DP was associated with a marginally but significantly higher HR for earlier exit from paid work in cohort A (women 1.08; 95% CI: 1.06-1.10; men 1.10; 1.08-1.12), lower HR for men in cohort B (0.93; 0.86-0.99), and non-significant HR for women in cohort B. The corresponding association for mental SA/DP was significant only for women in cohort A (1.09; 1.06-1.13). Conclusions The likelihood of earlier exit from paid work was slightly higher for those aged 65-69 at baseline with prior somatic SA/DP, but lower for men aged ≥70 at baseline with prior somatic SA/DP. Prior mental SA/DP was associated with earlier exit only for women aged 65-69 at baseline. Key messages • Prior SA/DP was in many cases marginally but significantly associated with future income from work. The direction of association differed depending on the diagnosis of the spell, cohort and sex. • More knowledge is needed on how older workers with different types of morbidities and functional limitations can extend their working life in Sweden as well as in other European countries.

Labour market effects of the COVID-19 pandemic: A Dutch longitudinal study

Abstract Background The COVID-19 crisis has caused profound impact on societal, economic, and healthcare systems. The nature and distribution of these impacts, especially over longer periods of time, is still in need of further investigation. We aim to examine the prevalence of and determinants for poor labour market outcomes during the COVID-19 pandemic among adult workers in the Northern Netherlands. Methods We conducted a longitudinal study based on data from the Lifelines COVID-19 cohort. Data from 23 waves (March 2020 - November 2021) were used. Participants were workers between 18 and 64 years of age (n = 22,378). Dependent variables were labour market outcomes, i.e., unemployment, hours of work, quality of work and sickness absence. Independent variables are sociodemographic and work characteristics, pre-existing health conditions, COVID-19 disease, and government support measures. We employed logistic Generalised Estimating Equations (GEE) to estimate population effects. Results Decrease in hours and quality of work, and requiring sickness absence were markedly present in our sample. While the former seems to show partial recovery throughout the pandemic, the two latter seem to vary over time. The prevalence of unemployment was low. Using GEE, we have found erratic patterns of risk for the four labour market outcomes. Pointing to the vast heterogeneity of experiences and impacts on the labour market outcomes of workers. Women, for example, had higher odds of becoming unemployed (OR: 1.48, 95% CI: 1.23-1.79), but lower odds of decreasing their work hours (OR: 0.90, 95% CI: 0.86-0.93). Discussion The results of this study point to the unequal and heterogeneous impact of the COVID-19 pandemic, as well as the presence of less visible negative outcomes among workers, such as decrease in quality of work. For a complete rebound from this crisis, policy should be aimed at addressing these differential impacts among the population. Key messages • The impact of the COVID-19 pandemic on the labour market is more pervasive than can be attested by looking at unemployment rates. • The impact of the COVID-19 pandemic differed by labour market outcome and population subgroup, and policies should aim to address these differential impacts.

Barriers, facilitators and needs for self-direction in return-to-work: a multi-perspective study

Abstract Background Long-term sickness absence is not only an organizational, but also a societal public health problem. Many sick-listed workers experience challenges in self-directing their return-to-work (RTW), where RTW is considered as a gradual process in which work hours and tasks are gradually increased. This view of RTW as a process is common in several European countries, such as The Netherlands, Sweden, Denmark, Norway, Austria, Germany and Switzerland. Self-direction in RTW can reduce long-term sickness absence. The aim of this study is to provide a multi-perspective view on the experiences and needs regarding workers’ self-direction in RTW. Methods We conducted semi-structured interviews with (previously) sick-listed workers (n = 7) and focus groups with occupational physicians and labour experts (n = 10), case managers and job coaches (n = 6) and organizational representatives (n = 8). The interviews and focus groups were recorded, transcribed and coded thematically by two independent researchers. Preliminary results All stakeholders considered (self-directing) RTW as a learning process. Barriers to self-direct RTW were lack of sufficient support from employers and involved RTW professionals, lack of knowledge about the RTW process and responsibilities among both workers and their supervisors, and employers complying with legal requirements rather than applying a person-centered approach. Workers and the involved professionals emphasized the need to gain insight into long-term employability perspectives and scenarios to maintain work. Conclusions This qualitative study shows that there is a need for knowledge among workers and person centered support in RTW. The findings can be used in policy and practice to improve self-direction of sick-listed workers during RTW. Key messages • (Self-directing) RTW is a learning process for sick-listed workers. • Sick-listed workers need knowledge and person-centered support from employers and professionals to self-direct RTW.

Life course patterns after parental leave: a 10-year Swedish cohort study with sequence analysis

Abstract Background Knowledge on long-term life course patterns after parental leave is limited. We examined future work-, family-, and sickness absence (SA) and disability pension (DP) life courses after parental leave in Sweden and the baseline factors associated with them. Methods A prospective cohort study using nationwide register microdata, including all women (n = 43,959) and men (n = 43,514) with their first parental leave benefit in 2010. We used sequence analysis to examine their work-, family-, and SA/DP-related life-course patterns for the 10-year follow-up. Multinomial regression analysis was used to analyse the associations of baseline sociodemographics and morbidity with specific cluster membership. Results Four life-course sequences were identified for both women and men. ‘Employment/studies’ (47% of women, 88% of men); ‘Employment/studies & parental leave’ (37% of women); ‘Rapid return to employment/studies’ (6% of men); ‘Slow return to employment/studies’ (9% of women); ‘Low level of employment/studies’ (6% of women, 5% of men); and ‘Increasing sickness absence & disability pension (SA/DP)’ (1% of men). In women, low education (OR range 4.31-58.02), immigrant background (OR range 1.37-3.95), and morbidity (OR range 1.08-1.91) were associated with being in the ‘Employment/studies & parental leave', ‘Slow return to employment/studies', or ‘Low level of employment/studies’ life courses compared with the ‘Employment/studies’ life course. In men, the associations with low education (OR range 4.30-12.98), immigrant background (OR range 2.64-5.71) and morbidity (OR range 1.54-8.01) were found for ‘Rapid return to employment/studies', ‘Low level of employment/studies’ and ‘Increasing SA/DP'. Conclusions After the first parental leave, women have more often than men life course patterns of slow return to work or alternating periods of employment and parental leave. Education, birth country, and morbidity are associated with future life course patterns in women and men. Key messages • After the first parental leave, women have more variable working life courses than men, with more women with patterns of slow return to work or alternating periods of employment and parental leave. • Prior low education, immigrant background, and morbidity are associated with more variable life course patterns among both women and men.

Impact of the reform adding new sickness allowance checkpoints on rehabilitation and employment

Abstract Background In 2012, new sickness allowance checkpoints after 30, 60 and 90 sickness absence days were introduced in Finland to improve earlier detection of long-term work disability and to fasten return to work after illness. We examined whether the reform affected participation in rehabilitation and employment outcomes one year after the start of sickness allowance. Methods We conducted an interrupted time series analysis among working-age persons accumulating at least 30, 60 and 90 sickness allowance days and starting their SA during a time span covering three years before the reform and two years after the reform. Poisson regression analysis controlling for seasonal variation, gender, age, and education level was used. Results After the reform, the probability of receiving rehabilitation within one year after the start of a sickness allowance period lasting at least 30 days was increased by 5.1% (IRR 1.051, 95% CI 1.015-1.086). The increase after the reform was slightly larger regarding the 60 and 90 day checkpoints. Looking at the type of rehabilitation, vocational rehabilitation from the earnings-related pension scheme increased the most. Regarding the rehabilitation provided by the Social Insurance Institution of Finland, vocational rehabilitation, medical rehabilitation, and discretionary rehabilitation increased, but only the latter increase was statistically significant. In contrast to rehabilitation, changes in employment outcomes (employment, unemployment, sickness allowance and disability pension) after the reform were negligible. Conclusions The introduction of new sickness allowance checkpoints increased participation in rehabilitation but did not affect employment outcomes one year later. The results indicate that the reform only partly succeeded in fulfilling its goals. Future policy changes should seek to find measures to help people enter the labor market after rehabilitation. Key messages • The introduction of new sickness allowance checkpoints after 30, 60 and 90 sickness absence days increased rehabilitation but did not affect employment outcomes one year later. • Future policy changes should seek to find measures to help people enter the labor market after rehabilitation.

Long-term sickness absence among adults with ADHD: the role of psychosocial working conditions

Abstract Background Symptoms of Attention-deficit/hyperactivity disorder (ADHD) do not only occur during childhood but often persist into adulthood and affect individuals’ ability to work. Adults with ADHD compared to those without ADHD are at a higher risk of negative labour market outcomes, such as long-term sickness absence (LTSA). Identifying modifiable factors in the workplace such as psychosocial working conditions may be a plausible strategy to lower this risk. This study aimed to investigate the effect modification of job control and job demands on the risk of LTSA among adults with ADHD. Methods The study population consisted of around 3.7 million individuals aged 20-60 years in Sweden in 2009. Of them, 0.3% had a diagnosis of ADHD extracted from the national patient registers. LTSA was defined as having one sick-leave spell of 90 days or more between 2010-2020. Job control and job demands were measured using job exposure matrices. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of LTSA among adults with ADHD compared to those without. Stratified analysis was conducted to test the effect modification by job demand-control status. Results During the follow-up, 812,971 (22%) adults had LTSA. Both men and women with a diagnosis of ADHD were at a higher risk of LTSA (HR 1.75, 95% CI 1.68-1.82 and HR 1.61, 95% CI 1.55-1.68, respectively) compared to those without ADHD, after adjusting for demographics, previous LTSA, and other mental and somatic disorders. The increased risk of LTSA among adults with ADHD was present regardless of the levels of job control, job demands and job demand-control categories (HRs ranged from 1.55 to 2.10). Conclusions Adults with a diagnosis of ADHD have a higher risk of LTSA and job demand-control status does not seem to substantially modify this risk. Future studies identifying factors in the workplace that may potentially help prevent LTSA among adults with ADHD are highly warranted. Key messages • Adults with ADHD have a higher risk of LTSA regardless of the job demand-control status. • There is an urgent need to identify factors that may help improve the work ability of this population.

Digital Training Program for Line Managers (Managing Minds at Work): Protocol for a Feasibility Pilot Cluster Randomized Controlled Trial.

Mental health problems affect 1 in 6 workers annually and are one of the leading causes of sickness absence, with stress, anxiety, and depression being responsible for half of all working days lost in the United Kingdom. Primary interventions with a preventative focus are widely acknowledged as the priority for workplace mental health interventions. Line managers hold a primary role in preventing poor mental health within the workplace and, therefore, need to be equipped with the skills and knowledge to effectively carry out this role. However, most previous intervention studies have directly focused on increasing line managers' understanding and awareness of mental health rather than giving them the skills and competencies to take a proactive preventative approach in how they manage and design work. The Managing Minds at Work (MMW) digital training intervention was collaboratively designed to address this gap. The intervention aims to increase line managers' knowledge and confidence in preventing work-related stress and promoting mental health at work. It consists of 5 modules providing evidence-based interactive content on looking after your mental health, designing and managing work to promote mental well-being, management competencies that prevent work-related stress, developing a psychologically safe workplace, and having conversations about mental health at work. The primary aim of this study is to pilot and feasibility test MMW, a digital training intervention for line managers. We use a cluster randomized controlled trial design consisting of 2 arms, the intervention arm and a 3-month waitlist control, in this multicenter feasibility pilot study. Line managers in the intervention arm will complete a baseline questionnaire at screening, immediately post intervention (approximately 6 weeks after baseline), and at 3- and 6-month follow-ups. Line managers in the control arm will complete an initial baseline questionnaire, repeated after 3 months on the waitlist. They will then be granted access to the MMW intervention, following which they will complete the questionnaire post intervention. The direct reports of the line managers in both arms of the trial will also be invited to take part by completing questionnaires at baseline and follow-up. As a feasibility pilot study, a formal sample size is not required. A minimum of 8 clusters (randomized into 2 groups of 4) will be sought to inform a future trial from work organizations of different types and sectors. Recruitment for the study closed in January 2022. Overall, 24 organizations and 224 line managers have been recruited. Data analysis was finished in August 2023. The results from this feasibility study will provide insight into the usability and acceptability of the MMW intervention and its potential for improving line manager outcomes and those of their direct reports. These results will inform the development of subsequent trials. ClinicalTrials.gov NCT05154019; https://clinicaltrials.gov/study/NCT05154019. DERR1-10.2196/48758.

Determinants of long-term sickness absence trajectories among 19–39-year-old employees with pain

Abstract Background Previous studies have shown higher long-term sickness absence (LTSA) rates among employees with pain as compared to those not reporting pain. We examined distinct developmental patterns in LTSA (≥10 consecutive working days) among young and early midlife employees with pain at baseline, and factors associated with LTSA trajectories. Methods The study population consisted of 19-39-year-old employees (n = 1685) of the City of Helsinki who reported current pain at baseline in 2017. Data on all-cause LTSA days through March 2020 were collected from the Social Insurance Institution of Finland. Group-based trajectory modelling was used to identify distinct all-cause LTSA trajectories. Multinomial logistic regression was used to examine associations of pain characteristics, lifestyle- and occupational factors with trajectory group membership. Results Three distinct LTSA-trajectory groups were identified; No LTSA (74%), Decreasing (18%), and Increasing (8%). Compared to the No LTSA trajectory, employees in the Decreasing trajectory were more likely to have chronic (OR 1.34, 95% CI 1.04-1.73) or multisite (OR 1.81, 95% CI 1.36-2.41) pain, smoke (OR 1.55, 95% CI 1.18-2.03), have obesity (OR 1.70, 95% CI 1.21-2.38), manual or routine non-manual occupation (OR 1.87, 95% CI 1.31-2.67) and high physical workload (OR 1.47, 95% CI 1.14-1.90), after adjusting for age and gender. Predictors of the Increasing trajectory were not identified. Conclusions Distinct LTSA-trajectories were identified among young and early midlife employees with pain, of whom a majority had no LTSA during follow-up. Chronic and multisite pain, unhealthy lifestyle, lower occupational class, and higher physical workload are related to a pattern with more LTSA. Future intervention studies could examine opportunities to prevent LTSA through supporting younger employees who work with pain and have these risk factors. Key messages • Distinct trajectories of LTSA were identified among younger employees with pain, of whom most had no LTSA. Pain characteristics, lifestyle and occupational factors predicted trajectory membership. • Future intervention studies could examine opportunities to prevent LTSA through support to employees who work with pain and have pain-, lifestyle- and occupation related risk factors of LTSA.

Working conditions and self-efficacy among users of psychotherapeutic consultation at work

Abstract Introduction Psychotherapeutic consultation at work (PT-A) aims to prevent sickness absence and to facilitate return to work by offering early intervention and treatment for employees with (subclinical) symptoms of mental disorders. PT-A specifically considers work-related aspects to increase occupational self-efficacy, which is a predictor for work ability and return to work. This study investigates which psychosocial working conditions are related with occupational self-efficacy among employees who enrolled for PT-A. Methods This cross-sectional analysis uses baseline data of 536 participants of a randomized controlled trial (friaa-study) investigating the effect of PT-A in Germany. Psychosocial working conditions were measured by the Copenhagen Psychosocial Questionnaire (COPSOQ) using the following subscales: quantitative and emotional demands, decision authority, possibilities for development, leadership quality and social support. Occupational self-efficacy was measured by the short form of the Occupational Self-Efficacy Scale. Associations between psychosocial working conditions and occupational self-efficacy are calculated by multiple linear regression. Results Quantitative job demands are negatively (b=-0.118, SE = 0.047, p<.05) and possibilities for development (b = 0.284, SE = 0.049, p<.001) are positively associated with occupational self-efficacy. Interactions between sex and decision authority (b = 0.228, SE = 0.097, p<.05) and social support (b=-0.273, SE = 0.101, p<.05) suggest that occupational self-efficacy is only associated with social support among male and only associated with decision authority among female participants. Conclusions Results suggest that psychosocial working conditions and particularly quantitative job demands, decision authority, possibilities for development and social support should be addressed during PT-A. However, longitudinal data ought to shed light on the causal relationships between working conditions and occupational self-efficacy. Key messages • Results suggest that adverse psychosocial working conditions are related to lower levels of occupational self-efficacy among users or PT-A. • It might therefore be useful to address psychosocial working conditions with employees visiting PT-A.

Learning how to recover from stress: Results from an internet-based randomized controlled pilot trial

IntroductionThis randomized, controlled pilot trial evaluated the efficacy of a brief internet-based recovery training intervention targeting a clinical sample of distressed employees. MethodA sample of 69 employees with elevated symptoms of stress were assigned randomly to a five-week guided recovery training intervention (iRTP, n = 35) or a wait-list control (WLC, n = 34). The study was conducted in Sweden and participants enrolled via an open recruitment strategy. Self-report data were collected pre- and post-intervention, then six and 12 months after the intervention. The primary outcome measure was the Recovery Experience Questionnaire (REQ. The secondary outcome measures gauged other relevant mental and work-related health outcomes. Participants in the wait-list control group received access to iRTP after the six-month follow-up. ResultsCompared with the controls, participants in the intervention group showed a significant and large overall improvement on the primary outcome REQ (d = 0.93), and small to moderate effects on the secondary outcomes including, perceived stress (d = 0.48), anxiety (d = 0.49), quality of life (d = 0.47), and work ability (d = 0.47) during post-assessment. No significant differences were found at any time point regarding burnout, exhaustion, depression, physical exercise, work experience, or sickness absences. ConclusionThis pilot trial is one of the first to examine a brief recovery training program's efficacy, suggesting that employees across a wide range of professions could learn how to recover from elevated stress symptoms. This type of accessible and brief recovery intervention could potentially prevent and reduce the negative effects of stress, as well as improve recovery and quality of life. However, more research is needed with larger samples before further conclusions can be drawn. Trial RegistrationThe study was registered at Clinical Trials (clinicaltrials.gov) number NCT05220592.

Factors associated with return-to-work outcomes in inpatient rehabilitation – a systematic scoping review

ABSTRACT Inpatient rehabilitation is common in Germany to improve return-to-work outcomes. The objective of this systematic scoping review was to identify factors associated with return-to-work outcomes in musculoskeletal, psychological and oncological health conditions to improve tailoring of rehabilitation therapies. A search was completed in Embase, Medline, PsycInfo and AMED until May 2023 for articles investigating inpatient rehabilitation including working-age patients with oncological, musculoskeletal, or psychological diseases using a quantitative design and reporting factors associated with return-to-work outcomes. Screening of all titles and abstracts was completed by one reviewer, full texts were read by two reviewers. Quality appraisal and data extraction was completed by two reviewers. Data was analysed using a narrative synthesis. Eighteen studies of moderate quality were included. The review identified a wide range of return-to-work parameters including employment status, work ability, sickness absence, retirement status and duration of employment since rehabilitation. In addition, 48 psychological, health- and work-related factors associated with return-to-work parameters were identified. Only one RCT investigated the relationship between a depression prevention intervention and a return-to-work outcome (work ability), which showed a significant effect. In addition to the depression prevention intervention, only the factor ‘health literacy’ could be considered modifiable and be addressed as part of an inpatient rehabilitation programme. Furthermore, gradual work reintegration programs and/or workplace interventions in addition to inpatient rehabilitation should be further explored to improve return-to-work outcomes.

Presenteeism, Job Satisfaction, and Psychological Distress among Portuguese Workers in a Private Social Solidarity Institution during the COVID-19 Pandemic: A Cross-Sectional Study

Under normal circumstances, the working population exhibits high levels of psychological distress and presenteeism, a scenario which was exacerbated by the COVID-19 pandemic. Moreover, few studies have analyzed presenteeism during the COVID-19 pandemic, prompting the current research. We aimed to explore the levels of presenteeism and associated factors, job satisfaction, and psychological distress in a sample of Portuguese workers in a Private Social Solidarity Institution (the acronym in Portugal is IPSS). In 2022, an observational, cross-sectional survey of workers from an IPSS in the central region of Portugal was conducted. The study included a total of 71 employees who granted written permission. The survey collected general and professional information, as well as the Stanford Presenteeism Scale (SPS-6), the Job Satisfaction Questionnaire (S20/23), and the Kessler Psychological Distress Scale (K10). Presenteeism was reported by 32 (45.1%) workers and sickness absence by 38 (54.3%). Most of the individual S20/23 evaluations indicated a greater level of satisfaction (mean ≥ 4.5 pts.), except for the question related to salary, which received a higher level of dissatisfaction (mean = 3.36 ± 1.9 pts.). Around 50.7% of participants had a high or very high risk of suffering or of suffering a mental disorder. The correlation matrix indicated a significant moderate positive correlation between presenteeism and job satisfaction and a significant moderate negative correlation between presenteeism and psychological distress (p < 0.01). We found five predictors for presenteeism: marital status, quality of sleep, sickness absenteeism, health perception, and psychological distress (R2 = 0.358). We anticipate that our results will spark more studies about the practical consequences of presenteeism for fostering better health and well-being at work.